Alopecia areata is manifested by circular, clearly limited areas on the scalp which are missing hair.

Etipathogenesis - (occurrence and development) has not been completely clarified, as the factors which cause alopecia areata are rather different. Approximately 25% of the cases refer to genetic predisposition and are considered to be dominant type of inheritance. Emotional stress, tension, nutrition disorders and many other factors can only be triggers for the appearance of disease symptoms. Even though specific antibodies have not been discovered, alopecia areata is frequently interpreted as autoimmune disease, as there are indirect evidence in terms of peribulbar lymphocytic infiltrate, correlation between alopecia areata and autoimmune diseases (thyreoiditis, allergies, atopy, asthma, etc.), frequent presence of organ-specific antibodies and hair growth after corticosteroid treatment. Additionally, alopecia areata may be caused by sciatica and enzymopathy.

At alopecia areata, anagen follicle (active growth phase) turns to telogen (resting phase) follicle, which is manifested by hair loss. Depending on the damage, follicle can create normal hair, dystrophic hair, or complete lack of hair which is characteristic for most serious stage of the diseases. However, damaged follicles may keep their potential for regeneration and thus hair re-growth may occur even in long-term forms of the disease. In some cases, the hair looks like an exclamation mark- distal part of the damaged hair is broken in the form of longitudinal cleavage, while the lower part becomes thinner and ends in telogen root “head”.

Clinical presentation – alopecia areata may appear in early childhood. However, first visible changes usually occur between the ages of five and thirty. Women are more likely to suffer from this disease than men. The first sign of hair loss is visible on the scalp, but may also appear on eyebrows, eyelashes, male beard or on affected skin. In active stage of the disease, hair falls out along the edges of the tugged area and looks like “exclamation mark”. At serious forms of the disease, hair falls out from remote, clinically unchanged areas, which is a rather bad prognostic mark.

Ophiasis – derives from the word “ophis” – “snake” and is characterized by extended hair loss along occipital edge of the scalp. This is a sign of serious form of alopecia areata, as it leads to alopecia totalis.

Alopecia totalis– is a total hair loss which starts as spot boldness, but is spread to the entire scalp, while the rest of the body hair remains intact.

Alopecia universalis – is the hardest form of the disease as hair loss occurs at hair, chin, eyebrows, eyelashes, axillary (armpit), pubic and vellus. The entire skin is pale and atonic.

A.totalis and A.universalis are also called malign alopecia, as spontaneous hair re-growth occurs on very rare occasions.
More complex forms of alopecia are characterized by changes on the nails- longitudinal ridges, spots and cracks. Changes on the eyes, in the form of cataract, may also appear.

Progression of alopecia areata is very unpredictable and recidivism occurs at practically all patients (who are to be monitored, sometimes for more than twenty years). A.a. which becomes limited after six months has a good prognosis. Patients who suffer from A.a. before puberty, atopic patients and patients with ophiasis are not facing such a favorable prognosis. At easier forms of the disease, hair grows spontaneously after three to five months, firstly at the center in the form of lanugo hairs which become darker and stronger in time, while remission periods can be very long (up to several years). However, at alopecia universalis and totalis, spontaneous hair re-growth is very rare and therapy is successful in only 20 % of the cases.
In terms of differential diagnosis, A.a. is to be differentiated form lupus erythematodes discoides and pseudopelade which are characterized by the occurrence of cicatricial (scarring) alopecia.

Treatment – in majority of cases treatment depends on individual medical history and scanner results.

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